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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 434415371
Report Date: 02/11/2020
Date Signed: 02/11/2020 04:54:05 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME:KCE CHAMPIONS LLC @ LEDESMA ELEMENTARYFACILITY NUMBER:
434415371
ADMINISTRATOR:HELEN DE LA CRUZFACILITY TYPE:
850
ADDRESS:1001 SCHOOLHOUSE ROADTELEPHONE:
(408) 707-9381
CITY:SAN JOSESTATE: CAZIP CODE:
95138
CAPACITY:55CENSUS: 52DATE:
02/11/2020
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Ilse RichterTIME COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Fermin Campos-Jaramillo conducted an unannounced annual inspection to the Facility today. LPA met with Ilse Richter, Site Director, and explained the nature of today's visit to her. LPA toured the Facility both inside and outside during today's inspection. LPA observed the required posted materials. LPA at arrival observed 2 staff members and 52 school age children. LPA observed a teacher aid arrived at 3:00 PM, and another teacher (Ms. Tamara) arrived at 2:40 PM The center is located in two adjoined portable classrooms of the Ledesma Elementary School.

LPA observed the Information and Emergency Information form in a random sample of 10 children’s files. LPA reviewed the files of three staff members. The health screening is in each staff file. Valid pediatric CPR/First Aid cards for at least one of the staff present today. Site Director understands that there shall be at least one person, with valid CPR and First Aid certifications, on site at all times or present during off-site activities (field trips). LPA observed proof of immunization for measles, pertussis and influenza in the staff files in compliance with the SB792. LPA observed that the teacher/child ratio was not in compliance during today's inspection. Site Director understands the conditions, limitations, and capacity specifications of the Facility license. Site Director understands that children shall be visually supervised at all times. LPA reviewed the sign-in and sign-out of children which has full signatures.

LPA observed that rooms are clean and safe for all children and staff. Drinking water is readily available for the children in each room and water to be available via water fountain. LPA observed children's bathrooms are clean, sanitary, and operable. Staff uses bathrooms located at the school office. Site Director states that there are no weapons on the premises. LPA observed the fire drill was documented on 1/14/2020. LPA observed there is at least one fire extinguisher size 3A40BC last serviced on January 2020, and smoke and carbon monoxide detectors.

Report dated 2/11/2020 continues in page 2.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131
FACILITY NAME: KCE CHAMPIONS LLC @ LEDESMA ELEMENTARY
FACILITY NUMBER: 434415371
VISIT DATE: 02/11/2020
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Report dated 2/11/2020 continues from page 1.

The snack food preparation area is adequately equipped with refrigerator, microwave oven, and sink with cold running water. Site Director stated the center provides snacks for the children enrolled. LPA observed the menu is posted. Cleaning supplies are inaccessible to the children. Any medications at the Facility are stored appropriately inaccessible to children.

LPA observed all furniture and equipment is in good condition and safe for the children. The playground outdoor surfaces are safe for the children. LPA observed that the outdoor equipment is age appropriate and in fair/good condition. LPA observed rubber mulch as resilient material under the climbing structure in the playground, shade is provided by overhang building for solar panels. LPA did not observe any bodies of water.

A review of staff records on 2/06/2020 indicates that all Facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. LPA also reminded director of the applicable civil penalties for those adults who have not received fingerprint clearances, are not associated to the license and who come in contact with or provide care and supervision to the children. Penalty amounts: $100.00 per person per day, minimum of $100.00 to a maximum of $500.00 per person for an initial violation and a minimum of $100.00 to a maximum of $3000.00 per person for any subsequent violations within a 12-month-period.
LPA observed all staff members have in file expired proof of completion of the Mandated Reporter training. Site Director understands the training shall be renewed every two years. Additional information on the training is available at: www.mandatedreporterca.com

Licensing Forms, Title 22 Regulations and information can be obtained through the internet at: http://www.ccld.ca.gov. LPA printed a check list of requirements for a Site Director and handed to Ms Richter. so Licensing Department can update her name in the System. Licensee understands change of Site Director shall be made within the initial 30 days of the change.

Type A and B deficiencies were cited.



NOTICE OF SITE INSPECTION WAS PRINTED AND HANDED TO SITE DIRECTOR AND MUST BE POSTED FOR 30 CONSECUTIVE DAYS
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2020
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KCE CHAMPIONS LLC @ LEDESMA ELEMENTARY
FACILITY NUMBER: 434415371
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/12/2020
Section Cited

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(a) In addition to Sections 101216.3(c), (e), (g) and (h), and notwithstanding Sections 101216.3(a), (b), (d) and (f), the following shall apply: b) There shall be a staffing ratio of one teacher and one aide present to every 28 children in attendance.
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(1) A teacher shall supervise no more than 14 children or with an aide a maximum of 28 children. This regulation was not met as evidenced by LPA observed at arrival 52 children present and only two teachers were present. Licensee understands this poses an immediate risk to the health and safety of the children in care.
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LPA discussed the requirements of AB633 to licensee and provided her the AB633 fact sheet and a copy of Acknowledgement of Receipt of Licensing Reports (LIC 9224) and licensee understands the requirements.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2020
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2580 N FIRST STREET, STE. 300
SAN JOSE, CA 95131

FACILITY NAME: KCE CHAMPIONS LLC @ LEDESMA ELEMENTARY
FACILITY NUMBER: 434415371
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2020
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/25/2020
Section Cited

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On or before March 30, 2018, a person who, on January 1, 2018, is a licensed child care provider, administrator, or employee of a licensed child day care facility shall complete the mandated reporter training provided pursuant to paragraphs (2) and (3) of subdivision (a), and shall complete renewal mandated
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reporter training every two years following the date on which he or she completed the initial mandated reporter training. This regulation was not met as evidenced by: LPA observed that staff members have expired certificates of completion since 1/31/2020
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Mary SeguraTELEPHONE: (408) 324-2152
LICENSING EVALUATOR NAME: Fermin Campos-JaramilloTELEPHONE: 408-334-8557
LICENSING EVALUATOR SIGNATURE:
DATE: 02/11/2020
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/11/2020
LIC809 (FAS) - (06/04)
Page: 4 of 4